Disturbing images get people thinking about health risks associated with tobacco, study finds

Researchers from Ohio State University found that photos of damage caused by tobacco use are more effective than words alone in deterring smokers.

"The graphic images motivated smokers to think more deeply about their habit and the risks associated with smoking," study co-author Ellen Peters, a professor of psychology, said in a university news release. "Policies requiring such labels have the potential to reduce the number of Americans who smoke."

The study followed 244 adults who smoked between five and 40 cigarettes daily. They were given their preferred brand, but some packages included graphic images along with a written warning such as "Cigarettes cause fatal lung disease."

The use of graphic warning labels was required in the United States in 2009, but the mandate was thrown out when a federal court declared the images "unabashed attempts to evoke emotion and browbeat consumers into quitting."

The court may have been wrong about the way the images affected smokers, the study authors suggested.

"Smokers weren't browbeaten by the images," Peters said. "What the court is missing is that without emotions, we can't make decisions. We require having feelings about information we collect in order to feel motivated to act. These graphic warnings helped people to think more carefully about the risks and to consider them more."

While some smokers in the study received only worded warnings, others received one of nine images intended to reveal the dangers associated with smoking. The U.S. Food and Drug Administration created the images, including one of a man with a tracheostomy smoking through the hole in his throat.

A third group received the typical words, the graphic image and more text describing how every cigarette poses a health risk.

Smokers who saw graphic images on each pack of cigarettes they smoked over four weeks had more negative feelings about smoking than those who only saw worded warnings. The pictures added credibility to the warnings and caused the smokers to think more about the harmful effects of tobacco use, the study published Dec. 21 in the journal PLOS ONE found.

"Our study provides real-world evidence of how viewing these graphic images over time has an impact on smokers beyond what occurs with simple text warnings," lead author Abigail Evans, a postdoctoral researcher in psychology, said in the university news release.

The study found those who received graphic images were more likely to closely examine their warning labels, remember them and consider quitting.

"The feelings produced by the graphic images acted as a spotlight. Smokers looked more carefully at the packages and, as a result, the health risks fell into the spotlight and led to more consideration of those risks," Peters said. "For a health issue like smoking, which causes about a half-million deaths a year in the United States, even small effects can have a large impact in the population. The effect was small, but it was not unimportant."